Abstract
BACKGROUND: Corneal ulcers are a major cause of visual impairment in developing countries. In Indonesia, severe infective ulcers often require keratoplasty (KP) to preserve ocular integrity and improve outcomes. AIM: To determine demographic, clinical and microbiological characteristics, complications, and KP outcomes in patients with moderate to severe infective corneal ulcers. METHODS: A retrospective review was conducted on patients with moderate to severe infective corneal ulcers who underwent KP between January 1, 2018 and December 31, 2020, with a minimum follow-up period of 3 weeks at the Ocular Infection and Immunology clinic of a tertiary referral hospital in Jakarta. Data were extracted from medical records. RESULTS: A total of 99 eyes from 99 patients with a mean age of 41.7 ± 16.2 years were included. Eight-nine eyes of corneal cases were located at the central cornea with > 6 mm lesion size (forty-one eyes). The culture positivity rate was 33%, primarily composed of Staphylococcus epidermidis. Eyeball integrity was maintained in all patients. Mean uncorrected visual acuity (VA) before KP was 2.50 and improved to 2.04 after 3 months of follow-up. Twenty patients with a cornea that was kept transparent achieved a VA of 0.40. Complications after KP appeared in 60 eyes, while secondary glaucoma was the most common complication (28 eyes), followed by graft failure (24 eyes) and graft rejection (14 eyes). CONCLUSION: Corneal ulcers are a common problem in Indonesia following eye trauma. Therapeutic and tectonic KP can preserve the integrity of the eyeball in moderate to severe cases, although complications are common.